Challenges in treating patients with major depressive disorder: the impact of biological and social factors.

Major depressive disorder (MDD) is frequently unrecognized and underdiagnosed by clinicians and thus remains untreated or inappropriately treated in routine clinical practice. Although the symptoms of MDD are widely acknowledged and recognized by clinicians, numerous epidemiological studies have reported that this disorder is more prevalent than had previously been thought, and that it is challenging to diagnose and treat, particularly because somatic symptoms and comorbid conditions are common in real clinical situations. MDD is associated with increased morbidity and mortality as well as with higher healthcare costs and more severe functional impairment. Therefore, optimal treatment for MDD should include collaboration focussed on comorbid physical diseases, rehabilitation aimed at restoring social functioning, and pharmacotherapy designed to ensure complete remission including psychological and physical symptoms, as well as functional recovery.